Assisted living decision requires questions and a lot of research

About 15 years ago, Miriam Cook was in her mid-70s and living in New Jersey. Like a lot of people who had lived in their own house for 50 years, it was getting to be a lot, especially after her husband died.

With her only family - a sister, son and grandchildren - living in New Hampshire, she decided she'd move back to the state where she grew up. Her son Brad Cook, a Manchester attorney, had suggested many places for her to live, and even drove her around to several. But that was pretty much all he had to do with her decision.

"It seems like that most of the time, the adult children aren't the ones making the decisions," Cook, 64, said of the conclusion that his mother would live in an independent and, ultimately, assisted-living facility. "She called up one day and said, 'I'm going to Taylor (Community in Laconia),' because she researched it and she picked it."

It can be an emotional decision for both the senior and his or her adult children to decide it's time to move into such a facility. However, there are several ways to make the decision easier on everyone,

Assisted living can come in the form of a freestanding residence, part of a nursing home, hospital, retirement community or independent housing complex, according to the New Hampshire Health Care Association (NHHCA). The NHHCA is a membership organization representing healthcare providers that advocate for individuals requiring health care,

Assisted living is sort of the halfway point between seniors living on their own and needing around the clock care. Assisted living facilities generally allow seniors to live somewhat independently in an apartment-like setting, but where they get assistance with daily living activities such as meals, bathing and dressing if necessary, and with medications.

Care at most facilities include 24-hour supervision, three meals a day, social activities and exercise programs, as well as laundry, linen, housekeeping and maintenance services.

These facilities are licensed by the New Hampshire's Bureau of Health Facilities Administration and, according to the NHHCA, are inspected once a year.

Assisted living residents are usually charged a daily rate and the resident, according to the NHHCA, usually meets those expenses with private funds. Sometimes, however, insurance will cover the cost, but that varies by facility and insurance companies.

One of the best ways a senior can find the right place is to the one making the decision.

Among the most important things to consider for Miriam Cook, her son said, was whether the community was a continuing care retirement community.

"So she knew no matter what happened, for the rest of her life she'd always have a place to live," he said.

And that turned out to be especially important about four years ago when his mother, by then in her late 80s, started needing more medical care. Because she had planned ahead, she was able to move within the same system, but down the street to an assisted living facility.

"Her bridge group was still very close," Cook said with a chuckle.

Location was also important when Maureen Ballester was helping her 84-year-old mom, Jeanne, move from South Carolina back to New Hampshire after Ballester's father died a couple years ago. Ballester said it was important to her that her mother was in a residence that was close by so they could visit often.

"My brother and I share the responsibility of taking care of mom and we both work full time," Ballester said. "So it was important that she was close by and wasn't lonely and that she had people around her that she could rely on."

According to the NHHCA, when it comes to location, it should also be something the senior likes, as well as convenient for visits. Additionally, it should be easy to get to shopping, medical services and entertainment areas.

Ballester said she and her mother both wanted to make sure there was plenty to do at the residence so that Jeanne Ballester wouldn't get bored.

Equally important, said Maureen Ballester was noting how the staff interacted with residents.

"I think the staff is hugely important," Ballester said and urged potential residents and families to "Really meet the staff and watch how they interact."

The NHHCA adds that it's crucial to ask about the residence's staffing patterns and philosophy, as well as the training and qualifications required for the staff. Of particular note, is how the staff has been trained to protect residents' dignity and privacy, according to the NHHCA.

The NHHCA also recommends only considering licensed homes and asking if the home has a formal quality assurance program. Also, if its staff regularly attends continuing educational programs.

It's also important to ask questions about whether the staff assists residents in administration of medication and, if so, what are their qualifications, according to the NHHCA. Additionally, ask if there are professional nursing services on-site, or will the staff help residents and families make arrangements with a home health agency, according to the NHHCA.

When it comes to moving in, the NHHCA suggest finding out beforehand what the moving process entails, as well as what paperwork will be required. They also suggest finding out if the residence is affiliated with a hospital or nursing home, should acute or long-term care be needed. If it is, find out if there is a priority admission process. It's also key to know if the senior needs hospital or nursing home care, whether theroom will be held and if there are associated fees.